(A)
Application for license as a pediatric respite care
program shall be made on forms prescribed and provided by the director shall
include such information as the director requires, including the information
prescribed by paragraph (C) of this rule, and shall be accompanied by a
non-refundable license fee of six hundred dollars in the form of a check or
money order payable to the 'Treasurer, State of Ohio."

(B)
Any person or
public agency seeking to be licensed to provide a pediatric respite care
program shall submit an application for licensure at least sixty days prior to
the requested date for the inspection required by paragraph (A) of rule
3701-19-34 of the Administrative
Code.

(C)
An application for a license to provide a pediatric
respite care program shall include:

(1)
The name, address, and business telephone number of
the pediatric respite care program;

(2)
The names and
addresses of the persons having an ownership or control interest in the
pediatric respite care program and other information pertaining to ownership or
control of the program;

(3)
The corporate name of the pediatric respite care
program, if any, and the names, titles, addresses, and telephone numbers of its
officers and statutory agent;

(4)
A list of the
services which are or will be provided by the pediatric respite care program
either directly or indirectly through written contracts;

(5)
If services are
to be provided through contract, the identities of any contractors and the
services they will provide;

(6)
The number of
pediatric respite care patient rooms in the pediatric respite care program
facility; and

(7)
Documentation of compliance with the building code
standards required by paragraph (C) of rule
3701-19-48 of the Administrative
Code.

(D)
The applicant or an authorized representative shall
sign an affidavit included in the application certifying that, to the best of
his or her knowledge, the information in the application and any accompanying
material is true and accurate. If a representative signs the affidavit, he or
she shall include documentation that he or she is the applicant's authorized
representative.

(E)
An application for renewal of a license shall be made
at least ninety days prior to the expiration of the license. The application
shall be made and a renewal fee paid in accordance with paragraph (A) of this
rule in the same manner as for an initial license. A pediatric respite care
program shall submit documentation of continued compliance with the Ohio fire
code required by paragraph (C) of rule
3701-19-48 of the Administrative
Code, and a certificate of occupancy required by paragraph (C) of rule
3701-19-48 of the Administrative
Code only if it is different than the one previously submitted to the director.
The director shall renew the license if the program continues to meet the
requirements of Chapter 3712. of the Revised Code and Chapters 3701-19 and
3701-13 of the Administrative Code. If the program does not meet the
requirements, the director may deny renewal of the license, in accordance with
Chapter 119. of the Revised Code.

(F)
When reviewing a
license application, the director may request, in writing, that an applicant
furnish any additional information that the director determines to be necessary
to assess compliance with Chapter 3712. of the Revised Code and this chapter.
The applicant shall furnish any requested information within fourteen days
after the mailing of the director's request.

(G)
A pediatric
respite care program operating in another state seeking to provide services to
patients in Ohio shall establish an administrative office in Ohio and comply
with the rules of Chapter 3701-19 of the Administrative Code in order to obtain
a license. All pediatric respite patients' clinical records shall be maintained
at the Ohio administrative office.

(H)
Each licensed
pediatric respite care program shall notify the director, in writing, of any of
the following:

(1)
Any change in any of the information specified in the
license application under paragraphs (C)(1) to (C)(5) of this rule no later
than fifteen days after the change;

(a)
A change of ownership shall require the submission of
a change of ownership application on forms prescribed and provided by the
director; and

(b)
A non-refundable fee of two hundred dollars in the
form of a check or money order payable to the "Treasurer, State of
Ohio."

(2)
Any other change that would render the information
submitted in the license application inaccurate at least twenty-one days prior
to the effective date of the change; and

(3)
Any intent to
cease operation at least sixty days prior to ceasing operation. This
notification shall include a plan for assuring continuity of care for the
program's patients and their families after the program ceases operation. The
plan shall include procedures for assuring continuity of care for all pediatric
respite care patients that includes the folowing:

(a)
Provision of
written notice of the proposed closure of the program, at least sixty days
prior to ceasing operation, to each patient or patient's
family;

(b)
Development of a written discharge plan to be placed
in each patient's record to assist the person or public agency that will be
responsible for care of the patient and the patient's family after the program
ceases operation; and

(c)
Obtaining from each patient or the patient's
authorized representative written approval of any transfer to another licensed
pediatric respite care program and written authorization to release pertinent
clinical record information to such a program or another person or public
agency that will assume responsibility for the patient's and family's
care.

(I)
Each licensed
pediatric respite care program that seeks to increase or decrease the number of
pediatric respite care patient rooms as reported under paragraph (C)(6) of this
rule, shall apply for an amended license.

(1)
Application for
an amended license shall be made on forms prescribed and provided by the
director, shall include such information as the director requires, and shall be
accompanied by a non-refundable amended license fee in the form of a check or
money order payable to the "Treasurer, State of Ohio" in the following
amounts:

(a)
A
decrease in the number of patient rooms not involving a renovation, a fee of
two hundred dollars;

(b)
An increase in the number of patient rooms not
involving a renovation, a fee of two hundred dollars; or

(c)
An increase in
the number of patient rooms involving a renovation, a fee of six hundred
dollars.

(2)
Any increase in the number of pediatric respite care
patient rooms shall require an inspection in accordance with rule
3701-19-34 of the Administrative
Code.